~National Kidney Foundation & American Association for Clinical Chemistry Urges an End to Race-Based eGFR Equations and Addresses Critical Healthcare Needs of Transgender and Gender-Diverse Individuals~
(New York, NY – June 28, 2023) –The National Kidney Foundation (NKF) and the American Association for Clinical Chemistry (AACC) continue to challenge the status quo in kidney care through a report titled "Advancing Kidney Health: A Call to Action" for implementation throughout the United States. Published online on June 28th in the Journal of Applied Laboratory Medicine, the report provides in-depth laboratory information on the race-free estimating glomerular filtration rate (eGFR) equations and the biomarkers creatinine and cystatin C as well as implications to patient care, surpassing previous papers that addressed these topics. It also highlights considerations in eGFR values and reporting for transgender and gender-diverse individuals. Many large U.S. clinical laboratories have implemented the 2021 race-free eGFR equations but the National Kidney Foundation’s goal is nothing less than complete implementation. "Advancing Kidney Health: A Call to Action” reinforces the profound impact of race-agnostic eGFR equations on kidney disease diagnosis and management decisions, advocating for their adoption to ensure accurate and equitable care for all patients. Additionally, it explores uncharted territory by focusing attention on eGFR values and reporting on transgender and gender-diverse individuals, acknowledging their unique healthcare requirements.
The full report can be found here: https://academic.oup.com/jalm/advance-article/doi/10.1093/jalm/jfad022/7187513
A key finding of the report underscores the urgent need to abandon race-based calculations in medicine in general, one of which is the eGFR equations used to assess kidney function. The previous practice of incorporating race as a factor in estimating kidney function perpetuates misunderstandings, bias, and may inadvertently contribute to inequitable outcomes. The report emphasizes that race and ethnicity are imprecise social constructs incorporating one biological construct of genetic ancestry with subjective assessments of physical appearance, language, and culture. Relying on the social classifications in medical algorithms like those used in eGFR is fraught with difficulties and may lead to implicit bias that can adversely affect clinical care. Notably, studies have shown the use of the Black race coefficient could result in delayed eligibility for kidney transplant referral. There are similar implications for medications and their dosing. Using eGFR calculated with a race variable to identify those eligible for a particular drug and its appropriate dose may lead to “underdosing". Moreover, clinical algorithms that incorporate race and ethnicity can imply health inequities are immutable facts rather than injustices that require interventions.
Importantly, the report also recognizes the need for accurate and inclusive healthcare for transgender and gender-diverse individuals. For the first time, attention is directed towards the assessment and interpretation of eGFR results specifically tailored to address the unique physiological characteristics of these populations. By understanding and accommodating their distinct healthcare needs, the report emphasizes the importance of providing equitable access to accurate diagnoses and optimal treatment for kidney diseases.
"We cannot ignore the pressing need to end race-based eGFR equations and to address the healthcare disparities faced by transgender and gender-diverse individuals,” said Kevin Longino, CEO of the National Kidney Foundation and a kidney transplant recipient. “By adopting race-agnostic approaches and considering the specific needs of this community, we can advance kidney health and ensure equitable care for all. This report marks a significant milestone in our journey toward inclusive and effective kidney healthcare."
As part of the release, the National Kidney Foundation is calling upon policymakers, healthcare professionals, patient advocacy groups, and the public to implement these changes. The report's recommendations serve as a vital roadmap for transforming kidney health practices, eliminating disparities, and promoting equitable healthcare outcomes for all individuals affected by kidney diseases.